The question is about row 4. ( Infection->No seroconversion->Viral Persistence(1-4%))

1. Is this true that chronic infection may be present, but no seroconversion occured in 1-4%

2. How I can detect it at 6 months term(or more), if no antibodies present, but there may be an infection?

Thanks a lot in advance for clarification!

Response from Dr. McGovern

Great question!

Lack of seroconversion is rare. That is why we don't recommend routine testing for HCV RNA in addition to HCV antibody as a routine screening test. I am not sure where those numbers of 1 to 4% come from since no reference is given since I would be happy to look up the reference for you.

In patients with suspected acute infection (eg, recent onset of shared injection drug use), I would check a HCV RNA and antibody, because the virus comes before the antibody. However, the HCV antibody does "catch up" over time and becomes positive in the vast majority of patients.

There are some case reports of patients who never seroconvert, but these are really unusual - like healthcare workers with lots of prior exposure. These patients usually do have immune responses found in their T cells. I am not aware of any major epidemiologic studies that have assessed lack of HCV antibody in chronic infection in a large study population.

Finally, what can happen over time is that patients can lose their HCV antibody...But that is different that never making it in the first place.

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